- A young child shows up to the medical office
with a basic upper respiratory illness,
stuffy nose, sore throat, mild fever.
Five days later, they're paralyzed.
This is happening across the United States,
and I want to talk about it
on this week's Wednesday Checkup.
(dramatic music)
A five-year old girl and her parents
come to a family medicine doctor's office
for a typical, run-of-the-mill upper respiratory infection.
In fact, the only reason the parents
are bringing the child in is because they wonder,
should she get antibiotics or not?
In taking the child's history, we find out
that the young girl has had a sore throat,
a dry, non-productive cough,
and some runny nose for about a day or two.
There's been no fever that's been recorded,
but the child has felt warm and sweaty at certain times,
maybe slightly decreased appetite, decreased activity level.
But, overall, the child is still playful, feeling well,
maybe a little bit fatigue.
On physical exam, the child has a high temperature
but not a fever because we classify fever
as 100.3 or higher, and the child has a temperature
of about 99.9, which isn't normal but not yet a fever.
The ears look totally normal, not red, not infected.
The throat, mildly red, no white spots,
no signs of outward bacterial infection.
The sinuses are non-tender.
There is some runny nose, but it's clear,
it's not green or overly mucousy.
The child's lungs are clear, there's no pneumonia.
The stomach is soft, it's not tender.
The reflexes are all totally normal.
And what the doctor figures out from the situation
is that the child is suffering
from an upper respiratory infection because of a virus.
Knowing that this condition is caused by a virus
and not a bacteria, the doctor recommended a few things.
First and foremost, no antibiotics
because they don't work on viruses.
He recommended rest, hydration, nasal saline
to rinse out the sinuses, over-the-counter medications
to keep the child comfortable, and the magic bullet,
green tea and honey to control that nighttime cough.
The parents were very happy with this plan.
They rated the doctor five out of five stars,
and they went home,
and the child started to get better each day.
However, on day six, the child suddenly developed arm
and leg weakness, very significant arm and leg weakness,
so much so that they called the doctor's answering service.
The on call doctor calls back, hears the whole history,
the child had a mild respiratory virus, five days later
it developed this arm and leg weakness,
and immediately told the mother,
"Ma'am, you need to bring your child
"to the emergency room right now because I'm afraid
"your child may have acute flaccid myelitis."
The condition the doctor's referring to, AFM,
has received a lot of publicity over the last year
because it's a frightening proposition
for anyone that has young children at home,
and I totally understand that.
Look, this is a rare illness, it's a mysterious illness,
but there are things that we do know,
and I'd like to discuss them here today.
What is AFM?
This is a neurological, polio-like disorder
affecting the nerves of the spine
that causes muscle weakness, decreased muscle tone
and at times even paralysis.
It most commonly affects children around the age of five.
What's scary about this
is, if the paralysis affects the respiratory muscles,
the child can stop breathing.
Because of this, the CDC states that 98% of patients
who have this condition end up hospitalized,
with more than half ending up in intensive care units.
The scariest part of all of this is that both the CDC
and doctors don't yet know what causes AFM.
We do have a strong suspicion that it's related
to these mild respiratory viruses
that come a week prior to the child developing AFM.
We've also noticed that, in areas of the country
where these respiratory virus are spiking,
we also see higher rates of AFM.
The prime suspect at this moment is enterovirus D68.
Normally, when children are infected with enterovirus D68,
they have some mild respiratory viral symptoms,
or they can be asymptomatic altogether,
and most don't develop AFM.
But some do, and we don't know the reason as to why.
You might be wondering,
what's the prognosis of this type of condition?
To be honest, they're not that great.
About 70 to 80% of children who are diagnosed with AFM
months later will still have some level of residual weakness
despite our best efforts at treatment.
But why now?
Is this like a newly discovered condition or something?
No, AFM has been around sporadically,
but in 2014 the CDC had noted a global epidemic of it
with the spiking cases here in the U.S.
We have noticed a pattern to this disorder,
where it spikes between August and October,
which is really interesting
'cause August is starting right now.
And it spikes every other year,
so in 2014 there was a spike in cases,
then in 2015 it kind of leveled off.
2016, spike, 2017, it kind of leveled off.
In 2018 last year, it was the biggest ever spike
and the most cases ever recorded with about 230 cases,
bringing up the total today to just around 600.
So what do we do if a child
is brought into the hospital and diagnosed with AFM?
This is where things get tricky.
Because we don't quite yet know the cause,
it's difficult for us to recommend a foolproof treatment.
If you visit the CDC website as a medical professional
to get advice on what you should do
with a child who has AFM, there's no good evidence.
There's things that we do do for these children
because they work in other neurological conditions,
like steroids, immunotherapy,
plasmapheresis, all these medical treatments.
But none of them have great evidence.
The only thing that seems to work very well
is early intervention for occupational and physical therapy.
What we're actually doing is having the child
retrain their nerves and muscles
so that they can function effectively once again.
I mentioned earlier that,
even though this is supposed to be an off year for AFM,
and we're not supposed to see a peak,
we still should be on the lookout for certain symptoms.
And that's because the earlier we can get a child
to the hospital with AFM, not only does the child
fare better, but we can get better samples
that we can then send to the CDC for future research.
Symptoms you should be on the lookout for
when it comes to AFM is difficulty moving the eyes
or drooping eyelids, facial droop or weakness,
difficulty with swallowing or slurred speech,
or sudden arm or leg weakness.
When doctors obtain samples from their patients,
they automatically request consent from these patients
to send them to the CDC for future research.
Actually, the NIH just gave
the University of Alabama Birmingham a $10 million grant
to study the natural history and progression of AFM.
So, how do we protect ourselves and children from AFM?
Well, first, you have to understand that,
while we suspect that there's a viral component,
this isn't a contagious illness in a sense that,
if a child has AFM and your child interacts with them,
that means they're gonna get it.
That's not how this works.
This is a sequela or a complication of the virus.
So just by following some simple steps,
you can protect yourself from viruses,
which then will protect you
from the complications of these viruses, such as AFM.
Those steps being practicing good hand hygiene,
always washing your hands.
Avoiding touching your face.
Washing and disinfecting commonly used surfaces.
Practicing good cough and sneeze hygiene, dap, dap.
If you're sick or your child is sick, please stay home.
And, most importantly, vaccinate yourselves
and your children because, when you get vaccinations,
you protect yourselves from the viruses
that can cause complications and kill.
In fact, the reason why we give the measles vaccine,
for example, is not necessarily to protect you from measles.
It's to protect you from the complications of measles.
Actually, there's an interesting fact to be had here.
Polio had complications that were very similar to this,
where children were becoming paralyzed,
not being able to move their arms and legs, and guess what?
Polio was eradicated because of vaccinations.
If you have any outstanding questions about AFM,
I'm gonna drop some reading links
down below in the description,
and please feel free to jump into the comment section.
You know I'm quite active there.
And don't forget, tomorrow night, Chasing the Cure Live
is premiering on TNT and TBS, or you could stream it online,
9:00 p.m. Eastern Standard Time,
6:00 p.m. Pacific, August 8.
See you there 'cause I'm gonna be watching it also.
As always, stay happy and healthy.